Kocher criteria for pediatric septic hip

The Kocher criteria are useful for distinguishing between septic arthritis and transient synovitis in a child presenting with a painful hip.  The criteria are as follows:

1.  Non-weight-bearing on affected side
2.  ESR > 40 mm/hr
3.  Fever
4.  Serum WBC > 12,000

Criteria met and probability of septic arthritis:
0/4   0.3%
1/4   3%
2/4   40%
3/4   93%
4/4   99%


References:  
1.  Kocher MS, Zurakowski D, Kasser JR>  Differentiating between septic arthritis and transient synovitis of the hip in children:  An evidence-based clinical prediction algorithm.  J Bone Joint Surg Am.  1999;81:1662-70.

How to insert an LMA

How to put in an LMA:

A Laryngeal mask airway, or LMA, is a supraglottic airway device.  An LMA is a great rescue airway when you encounter difficulty in intubating a patient.  It can also be used to as an easy and more effective alternative to bag-valve mask ventilation.

To insert an LMA:
1.  Make sure the device is deflated.
2.  Apply lubricant to the anterior and posterior surfaces of the LMA.
3.  Standing at the head of the bed, hold the device in the dominant hand and open the airway (jaw-thrust is helpful to get tongue out of the way).  Tip of index finger should rest on cuff-tube junction.
4.  Point the tip of the LMA at the hard palate and advance along the hard and soft palates using a circular motion.

5.  Stop when resistance is met and only the tube is protruding from the mouth.
6.  Inflate the cuff.  Proper placement is confirmed by ability to ventilate the patient, end-tidal CO2 return, and seeing the tube elevate slightly when cuff is inflated.